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NOTE: Make sketch of installation showing lot size and shape, loca i n of house, septic tanks, privies, water
supplies, etc. Note special problems existing on lot. Write in measur���� in order that installations may be located
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Person County Health Department �.
Sewage System Improvements Permit ..�
Date: �'� Thi Permit Void After 5 Years
Owner ,��� � SR# i �3� .
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Subdivision �e: . Lot #.
Lot Size: 4' �: Type of Dwelling:
Water Supply: Private: � Public: � �"'" ;' Community:
Bedrooms: 3 Garbage Disposal = j�[�Z.
Basement Basement F'i es�_
INFOR�TI�TIFE�$Y� . +�z.�' � , Yv
e•,,,;�a„�#\ _ �3- T�iL, .."' owner. piesentative
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Size of Septic Tank: ���' � gallons `Size of Pump"Tank: �
Nitrification Line: �d��."?t �
Depth of Stone: 12 inclies
Max Depth of Trenches: �
Altemative System: Conv. Pump LPP Pump �
Remarks:
-------------------------
Date Well Approved:
BY
Date a S te
BY
Contractor.
_ Well should be 100 ft� from any sewer system
_ Sanitarian 7_ � _ � 3
_ Sanitarian •
�ATE OF COMPLETION
__ — a
Sewage System location, installation, and protection must meet state and local �
regulations. Septic tank should be pumped out every 3 to 5 years and shall be maintained �
by owner.in such manner as not to create a public health hazard. Septic tank and'd �
nitrif'ication line must be inspected and approved by a member of the Person Counry �
Health Department before any portion of the installation is covered and put into use. If o
the site plans or intended use change this permit is subject to revocation. y�y
(G.S. 130 A-335F) m V� P
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i.ocation of sewage disposal sewage system sketched on back.
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(OVER) `�